Screening and Counseling for Unhealthy Alcohol Use in Primary Care Practices

Importance: Unhealthy alcohol use is a leading cause of preventable deaths and is associated with many societal and health problems. Fewer than one-third of people who visit primary care practices in the US are asked about or ever discuss alcohol use with a health professional. Objective: To evaluate the association between primary care practice facilitation and adoption of evidence-based screening and brief counseling for unhealthy alcohol use. Design, Setting, and Participants: The Stop Unhealthy Alcohol Use Now (STUN) single arm, multi-site implementation study was performed at 21 primary care practices across North Carolina between February 1, 2020, and September 1, 2023. Intervention: Enrolled practices received 12 months of the practice facilitation implementation strategy, including quality improvement coaching, electronic health record support (eg, creating smart phrases or flowsheets, retrieving data), and clinician training on screening and counseling for unhealthy alcohol use. Main Outcomes and Measures: Implementation outcomes reflected adoption of evidence-based screening and counseling, including number and percentage of adult patients who were screened for unhealthy alcohol use and who received brief counseling after a positive screening result. Results: The 21 practices served 54 294 adult patients (mean [SD], 3386.2 [3418.0] per practice). Mean screening rates increased significantly, from 17.4% (95% CI, 6.0%-28.9%) per practice to 57.6% (95% CI, 29.1%-86.1%) by the end of the second quarter of practice facilitation (primary outcome; P < .001). Among screened patients, a weighted 13.9% (95% CI, 6.8%-21.1%) had positive results. The percentage of adult patients with documentation of receiving brief counseling after a positive screening result increased from 0 to 32.3% (95% CI, 13.3%-51.4%) by the end of the second quarter of practice facilitation (P < .001). After month 6, assessment of the implementation outcomes showed sustainment. There was significant variability across participating practices for screening and counseling outcomes. Conclusions and Relevance: The findings of this quality improvement study suggest that practice facilitation was associated with increased adoption of evidence-based screening and counseling for unhealthy alcohol use when provided to small and medium-sized primary care practices. This increase is projected to substantially reduce the harms of unhealthy alcohol use.